Proposed Model of Care and Workforce Plan. The Future Requirements For Occupational Health Physicians in the Health Service, Ireland.

Transcription

1 Document developed by Proposed Model of Care and Workforce Plan The Future Requirements For Occupational Health Physicians in the Health Service, Ireland. Submission to National Doctors Training and Planning from Workforce Health and Wellbeing Unit Dr Lynda Sisson Consultant and Accredited Specialist in Occupational Medicine National Clinical Lead in Workplace Health and Wellbeing MB BCh BAO MPH ACOEM FFOMI MCRN Sibéal Carolan Workforce Development Lead MSc, R.N.T,.R.G.N.,R.C.N. NMBI Registration Number 4838 May 22 nd

2 Table of Contents Introduction... 4 Setting The Context... 5 Mapping of Occupational Health Services Service Delivery Units... 6 Table 1 Acute Services Profile... 6 Table 2.Community Services Profile... 6 Table 3.Additional Staff... 6 Current Occupational Health Metrics... 7 Integrated teams within Occupational Health Services Information Communications Technology within Occupational Health Services Drivers of Change Table 4. Public Health Service Employment Mission and Values of the HSE Proposed Model of Care for Occupational Health Services in the Health Service in Ireland Background The Experience of Occupational Health in the NHS, UK WHWU Proposed Model of Care for Occupational Health Services in Irish Health Services Context Minimum Service Levels for Occupational Health Services Occupational health data collection and information sharing in the Irish Health Service Engagement of and with Occupational Health Services in the Irish Health Service WHWU s Workforce Planning Methodology to support this Model of Care Context and National Approach Supply and Demand Analysis Overview of the Occupational Health Physician Establishment in the Irish Health Service Table 5.Overview of current specialist posts in the Irish Health Service Current Medical Career Pathways for Occupational Health Physicians

3 Faculty of Occupational Medicine, Royal College of Physicians in Ireland Current Levels/Grades Occupational Health Physicians and Irish Health Service Trends Specialist Registrar Training Positions Alternative Pathway Developing the Workforce Plan for the Heath Service Projected Need for Occupational Health Physicians Table 6 Estimated Projections for Occupational Health Physician Posts for Current Succession Planning Table 7. Profile of progression of Current Specialist Registrar Training Proposed Succession Planning Actions References Appendices Appendix 1 Framework for Health and Wellbeing Appendix 2. Standards for Occupational Health Services Appendix 3. Metrics to Monitor Quality of Occupational Healthcare Appendix 4 Measurement of demand Appendix 5 Departmental Structure Appendix 6 Capability Assessment Appendix 7 Staffing Establishments Appendix 8 Work & Well-being Survey (UWES)

4 Introduction The Workplace Health and Wellbeing Unit was set up in March 2016 under Priority 2 Staff Engagement within the Health Services People Strategy [ With reference to the HSE People Strategy We have clearly defined workforce planning as a key component of our people strategy and we recognise that across the health system a talented, committed workforce through their collective knowledge, skills and hard work provide excellent health services to those who need care and to the wider community. [ The areas of governance and responsibility for the Workplace Health and Wellbeing Unit are: Occupational Health Services Health and Safety Function Employee Assistance Programmes Staff Health and Wellbeing At a time when health resourcing costs are contracting, it is vital that services examine the potential to maximise the efficiency of their services and resources. The objective of workforce planning is to develop knowledge and intelligence data on the workforce, to inform decisions at local level and to drive improvements in Occupational Health service outcomes. Buchan (2001) defined workforce planning the method of achieving the best mix of staff and skills, required to deliver a defined level of care in a defined area of organisational activity. Occupational Health Services are reasonably well established in the Irish health care setting, however the future of the services have never been defined using a planned approach at national level As such this is the first initiative to identify and calculate the requirements for the future that ensure a sustainable future for the specialty and the service. This document presents information on current Occupational Health Physician Staffing Establishments in the Irish Health Service, and it proposes a model of care for future delivery of Occupational Health Services provision in the Health Service in Ireland, and finally it articulates WHWU S approach to maximize Occupational Health Physician roles in the context of workforce planning within the service. Recommendation 1. A National Workforce Plan for Occupational Health Physicians should be developed in The Faculty of Occupational Medicine is the Professional Body responsible for the co-ordination of a National Workforce Plan. The WHWU will support this project and provide necessary expertise. 4

5 Setting The Context The setting up of the Unit in March 2016 was in response to a number of reports and recommendations over the years. The Report of the National Task Force on Medical Staffing, 2003 (The Hanly Report) clearly recommended improvements in the organisation, structure and staffing of hospital systems to deliver care at its best. The McDonald and Melly review of Occupational Health Services in the Health Service Executive Dublin NE, 2008 and the publication of a Proposal for a Unified Health and Safety Function Consultation Paper following a Review of Health and Safety Performance within the HSE. Finally the publication of the Healthy Ireland Strategy ( ) and the HSE people strategy ( ), led directly to the set up of the WHWU as part of the HR portfolio. Key Work Areas are as follows: Comprehensive Integrated and Streamlined Supports for Employees in the Irish Health Service Providing a safe environment in which to work for all staff through standards and compliance with Health and Safety Legislation Development of Standards and a Quality Improvement Tool for Occupational Health Services Development of Standards and a Quality Improvement Tool for Employee Assistance Programmes and allied services Promoting Positive Health and Wellbeing for all staff under a defined framework Mapping of Occupational Health Services 2016 In April 2016 the Occupational health Services across Ireland were mapped. The following data was generated. Occupational Health Physicians: Please refer to Table 5 to page 27. Registered Nurses in Occupational Health Services 81 * excluding agency. 50 in Statutory and 31 in Voluntary Administration staff 47* excluding agency. 35 in Statutory 12 in voluntary Other grades Manual Handing Advisor 3 Senior Physiotherapist 1 Multi task attendant 1 Psychologist 1 Data Manager 1 Agency /outsourced provision of Occupational Health Services since the Melly Report (2008) has risen year on year and currently stands at 25%. Occupational Health Services are largely based in acute sites but serve a population across community and acute sites. Please refer to Table 1, 2 and 3 on page 6. 5

6 Occupational Health Services are provided to the following Service Delivery areas Table 1 Acute Services Profile Service Delivery Unit Staff Population RCSI Hospital Group 9358 Ireland East Hospital Group Dublin Midlands Group Saolta Hospital Group 9548 South /South West Hospital Group University of Limerick Hospitals Group 4078 Childrens Hospital Group 3229 Table 2.Community Services Profile Service Delivery Unit Community Health Organisation 1 Donegal /Sligo/Cavan /Monaghan Community Health Organisation 2 Galway /Roscommon/Mayo Community Health Organisation 3 Clare /Limerick /North Tipperary Community Health Organisation 4 Kerry /North Cork /West Cork Community Health Organisation 5 South Tipperary /Carlow /Kilkenny /Waterford/Wexford Community Health Organisation 6 Wicklow /Dun Laoghaire /Dublin South East Community Health Organisation 7 Kildare /West Wicklow /Dublin West /Dublin South City /Dublin South West Community Health Organisation 8 Laois /Offaly/Longford/Westmeath /Louth /Meath Staff Population Table 3.Additional Staff National Ambulance Service Health Business Services Primary Care Reimbursement Service Corporate Services

7 Current Occupational Health Metrics The following section presents an overview of the type of activity undertaken in an Occupational Health Service. The data identifies the key specialised and important services that are provided by an occupational health service. This data is recorded on a quarterly basis. Current ICT systems present challenges in terms of recording, tracking and interpretation. A new ICT system is due to be in place for year end, this will assist data collection and interpretation. 1. Pre Placement Health Assessment Numbers Paper Screens OHN medical OHP medical 2. Surveillance Defined as a programme of systematic health checks to identify early signs and symptoms of work related ill health and to allow action to be taken to prevent its progression. Surveillance Type Numbers Audiology DSE /VDU eye tests Night worker questionnaires sent Pulmonary Function Tests Category 1, Non Protection 7

8 3.Immunisation Status TB Status Positive IGRA Numbers Positive TST s Referrals to Respiratory Services Requiring LTBI Treatment Active TB diagnosis Vaccinations Hepatitis B Primary Course1 st vaccine Numbers Hepatitis B Primary course2 nd vaccine Hepatitis B Primary course3 rd vaccine Hepatitis B accelerated course1 st vaccine Hepatitis B accelerated course2 nd vaccine Hepatitis B accelerated course3 rd vaccine Hep B Booster Hep A & B Combined 1st vaccine Hep A& B Combined 2nd vaccine Hepatitis A& B Combined3rd vaccine Hep B secondary 1st vaccine Hep B secondary 2nd vaccine Hep B secondary 3rd vaccine Hep A 1st vaccine Hep A 2nd vaccine 8

9 BCG MMR1st vaccine MMR 2nd vaccine Varicella1st vaccine Varicella 2nd vaccine Pertussis Influenza Revaxis Diftivax Other: Blood Tests Hep B Titre Numbers Hep B Core Hep B Surface Antigen Hep B Repeat Serology Hep B Viral load Hepatitis A serology Measles Mumps Rubella Varicella Hep C antibody Hep C PCR 9

10 HIV Serum to Hold FBC U&E Glucose LFT Lipid Profile Carbohydrate-deficient transferrin (CDT s) Other: 4. Occupational Blood Exposures (OBE) Numbers Significant Injuries Percutaneous Human Bite ( which breaks the skin) Exposure of Broken skin to blood/ body fluids Exposure of mucous membranes to blood and body fluids (including the eye) Non-Significant injuries Superficial graze not breaking the skin Exposure of intact undamaged skin to blood and body fluid. Exposure to sterile or uncontaminated sharps 10

11 Occupational Health Key Metric Metric Source Notes Number and % Completeness of hepatitis B immunisation OH Records Number and % of sharps injuries managed in which injured member of staff was fully immunised against hepatitis B 5. Referrals Numbers New Self referrals New Management referrals*varying in complexity 6.Critical Illness Policy Assessments Type Numbers Clinic Visit Paper assessments Meet Criteria Failed to Meet Criteria 11

12 Occupational Health Key Metric 2, 3, 4: Metric Source Notes Range Time from receipt of OH Records Frequency distribution management referral to first appointment Time from first OH Records Frequency distribution appointment following receipt of management referral to delivery of a report to the manager Prevalence of referral of musculoskeletal disorder for treatment OH Records Number and % of patients seen after an absence Health & Wellbeing Improvement Framework of > 4 weeks because of a musculoskeletal disorder, who are under care of or have been referred to a treatment service by 6 weeks from the start of their absence Number and % 7.Referrals to Other Departments Department Number Physiotherapy Dermatology Orthopaedics Psychiatry Occupational Therapy Functional Assessment Other 12

13 8.Disease Outbreaks by Incident Type No. of No. of Incidents Staff Exposed Norovirus H1N1 Seasonal Influenza Vomiting & Diarrhoea unconfirmed TB Scabies Bacterial Meningitis Strep A Varicella Measles Mumps MRSA SSSS( Staphylococcal Scalded Skin Syndrome) Parvovirus B19 E Coli 0157 Other 13

14 9.Telephone Consultations (Not part of Management Referral and Self-Referral, lasting>15 minutes) Number of calls 10.Education & Training Training No. of Sessions No. Of Attendees Sharps Training Induction Other 11. Presentations No. of Sessions No. Of Attendees 12.Feedback Questionnaire Name of Survey Response Rate Client Feedback Manager Feedback 14

15 13. Number of Meetings/ Committees Attended Name of Committee Number Health & Safety Radiation Protection Infection Control Quality & Risk Other 14. Audits Title of Audits Total Numbers Completed This section has listed the type of activity provided by an Occupational Health Service. It demonstrates the various types of activity ranging from direct healthcare worker consultations, indirect activity and associated work. It must be acknowledged that Occupational Health Service provision involves clinical expertise and significant partnering with other services. 15

16 Integrated teams within Occupational Health Services Although the focus of this document is on Occupational Heath Physicians within the Irish Health Service, it must be noted that the WHWU is also conducting a number of workforce planning projects in relation to the role of the Advanced Nurse Practitioner, Clinical Nurse Manager, Clinical Nurse Specialist, administrative roles and case manager roles in occupational health services. The WHWU recognises the importance of inter professionalism in the context of workforce planning. The Unit is working on a number of transformational leadership projects for example the development of National Standards for Occupational Health Services, Standards for Employee Assistance Programmes and the development of a Healthy Doctor s Strategy. Each project involves teams from across the disciplines with clearly defined outcomes and a structured governance framework. Information Communications Technology within Occupational Health Services The WHWU recognises that the use of a national IT system is essential for information sharing and data collection in order to meet standards and Key performance Indicators. The WHWU is commissioning a new ICT for 2017/2018 as a priority. This will be central for data collection and management /interpretation of data. Historically a number of ICT systems are in place across Occupational Health Services in Ireland. There are two comprehensive OHS systems available nationally both of which have been invited to tender for service for a national system. It is recognised that the introduction of a national contract will result in economies of scale and the costs of introducing the new system will reduce in existing spend in the national service. This is a key transformational project for the Unit and is expected to be completed by year end. Drivers of Change The WHWU approach to work and activity will focus on transparency, flexibility and project-based work. It will involve transformational collective leadership. Occupational Health Services and Standards 16

17 Occupational Health Services are reasonably well established in the Irish health care setting. Following an international trend many OHS services were seeking an accredited service that would encourage standardisation of services.one of the first priorities of the newly formed Workplace Health and Wellbeing Unit was to commence a review of existing International OHS Standards. An approach was made to Health Information and Quality Authority. Following discussions, it was agreed that the service would develop unique standards in line with the Quality Assurance Framework (QAF) Safety and Quality Improvement Directorate. A workshop was held with HIQA to discuss the format and process to develop standards under this Framework. A Standards Project Group first met in October 2016 and on 6 occasions since. The group included representatives from Health and Safety, Staff Health and Wellbeing and Occupational Health Services Nationwide. In accordance with the Framework, an Expert Advisory group was convened and presented with an early draft in November 2016 and launched in May Information Technology: The potential to utilise IT as a means of delivering efficiency, reporting and as a stated requirement from staff involved in WHW activity was set out in detail in the Workplace Health and Wellbeing 2017 business plan. Significant support from the Office of the Chief Information Officer will result in key deliverable of a standards based IT system in The delivery of a cloud based E-Health system to support the work of occupational health, employee assistance and related activity is on target for delivery in Changing Workforce Nationally and Internationally The World Health Organisation Report 2016, Working for Health and Growth has recommended investment in the health workforce to stimulate and guide the creation of at least 40 million new jobs in the health and social sectors, and to reduce the projected shortfall of 18 million health workers. In 1976 the Faculty of Occupational Medicine was established at the RCPI and a 4 Year Specialist Training Scheme in Occupational Medicine commenced in Occupational Medicine is a clinical medical speciality that deals with the interface between health and work. Occupational Medicine involves preventative programmes such as vaccinations, surveillance, rehabilitation, advisory roles and optimising the health of employees. Although the role of the Occupational Health Physician has remained essentially unchanged for a last number of decades, the context has changed considerably. 17

18 The Role of the Registered Nurse working in the Occupational Health Service will also be developed with defined capabilities, competencies and up skilling in the WHWU Workforce Plan. The total number of Whole-time Equivalent staff employed in the public health services during the past decade has increased by 7% since The total number of consultant and non consultant hospital doctors has increased by almost 23% since 2007 with the largest increase of 26% in consultant posts. Non Consultant Hospital Doctors have increased by approximately 21 % during the same period. [Department of Health Trends ] There is a current total population of healthcare workers of 140,000. This include health service workers from both the HSE and the Voluntary Sector. As our working population ages teh demand for OHS will invariably increase It is imperative to view the levels of Public Service Employment as this has a direct effect on Occupational health Physician demand and deliverables. Table 4. Public Health Service Employment Grade Category % Change Medical/Dental Nursing Health and Social Care Professionals# Management/A dministration General Support Staff Other Patient and Client Care Total

19 Other drivers of change include the proposed new model of care that is outlined in the next section. Mission and Values of the HSE The HSE Mission clearly states that people in Ireland are supported by health and social care services to achieve their full potential. It identified access, safe, compassionate and quality care as priorities. The HSE Corporate Plan set our values of Care, Compassion, Trust and Learning. With the proposed changes in the Irish Health Services and the development of commissioning services/service provision in the CHO /Hospital Group Model, the most effective model of care is a central governance unit i.e. WHWU with areas covered geographically by defined Area /collaborative service delivery units, this is referred to as a hub and spoke model. The structure of each hub will include occupational health physician services, occupational health nursing services,employee assistance programmes, rehabilitation services, health promotion, health & safety, and the provision of governance and support. The targets for the area /collaborative service delivery units, hub and spoke model will be exactly as described by the Healthy Staff, Better Care for Patients In order to met these service needs there must be integration with local health and Safety, CISM services, rehabilitation services, health and wellbeing and counselling services. 1. Prevention of ill health caused or exacerbated by work 2. Timely intervention- easy and early treatment for the main cause of sickness absence. 3. Rehabilitation to help staff stay at work or return to work after illness 4. Health Assessments for work- to help manage attendance, retirement and related matters 5. Promotion of health and well being using work as a means to improve health and well being and using the workplace to promote health 6. Teaching and training encouraging staff and managers to support staff health and well-being 19

20 Proposed Model of Care for Occupational Health Services in the Health Service in Ireland Background This proposal forms part of a broader plan for integrated employee supports delivery. The current model of care for Occupational Health Services in the health services have been in place for the past 25 years. To date, there has been limited planning which has resulted in a fragmented service nationwide, with gaps in service and a lack of standardisation of services. The formation of the WHWU is the first opportunity to centralise and standardise a governance system for forward planning and clarification of the best model of care for OHS in the health services for the future. The Experience of Occupational Health in the NHS, UK In the UK in 2016 an All Party Parliamentary Group on Occupational Safety and Health (2016) stated that urgent action was necessary in order to manage the challenges with workforce planning. This report clearly stated the role of OHS in terms of value within the multidisciplinary team. It recommended urgent action to manage the demographics of OHPs to address the supply issue if the level of capacity of the occupational medicine workforce is to meet the demand and the age demographic of Occupational Health Physicians. The report recommended the following The NHS ensures that occupational medicine physician posts are part of safe, effective, quality assured multidisciplinary teams. Government and insurers explore how to incentivise employers to provide workers with access to multidisciplinary occupational health services Incentives for OHP s considering retirement 20

21 Third Level Colleges and Training Bodies to include occupational medicine within the curriculum The NHS Health and Wellbeing Improvement Framework (D.O.H 2011) articulated key responsibilities and the WHWU proposes to replicate this framework. Appendix 1 The Boorman Report (May 2015) on Health and Wellbeing in the NHS provides a vision of care focussed on health and wellbeing. The three main areas in the Boorman Report are: Organisational Behaviours and performance This is to be achieved by the development of prevention centred approaches to health and wellbeing. In addition developing and equipping leaders and managers. Achieving an exemplar service This is to be achieved by enhancing staff engagement, team engagement and conducting risk assessments and interventions. Embedding Health and well being in the NHS systems and infrastructure This is to be achieved through National and Regional levels. Health and Wellbeing must not be viewed as a separate addition to a system or function. WHWU Proposed Model of Care for Occupational Health Services in Irish Health Services Context The proposed Model of Care for OHS in the Irish Health Service is informed by and supported by evidence from the research and optimum workforce planning methodologies. The vast majority of best practice and evidence comes from the NHS, UK. Healthy Staff, Better Care for Patients (2011) proposed a realignment of Occupational Health Services for the NHS. From an Irish Health Service perspective, this model can be replicated. To provide services to prevent staff becoming ill or injured at work - this will be lead through the Health and Safety Function and Occupational Health Division of WHWU To actively promote health and well-being in the workplace through Occupational Health Divisions and Human Resources portfolios. 21

22 To maximise access to and retention of work through timely rehabilitation services through Occupational Health Services and Human resources portfolios and internal and external rehabilitation services. Three specific areas will be addressed within the proposed model of care for OHS for the Irish Health Service 1. Minimum Service Levels for Occupational Health Services One of the first priorities of the Workplace Health and Wellbeing Unit was to commence a review of existing International OHS Standards. In accordance with the Quality Assurance Framework (QAF) Safety and Quality Improvement Directorate, A Standards Project Group and an Expert Advisory group was formed. The group included representatives from Health and Safety, Staff Health and Wellbeing and Occupational Health Services Nationwide. The draft standards were sent out for broad consultation, including to service users, in April Standards for Occupational Health Services for The Irish Health Service were launched in May The Following Themes form the basis for the Occupational Health Standards which will be supported using the HSE Quality Assessment + Improvement Framework Theme 1: Theme 2: Theme 3: Theme 4: Theme 5: Worker Centred Care Safe Effective Care Workforce Planning and Resources Leadership, Management and Governance Use of Information As described, Occupational Health Services will provide six core services informed by the above themes: 1. Prevention of ill health caused or exacerbated by work 2. Timely intervention- easy and early treatment for the main cause of sickness absence. 22

23 3. Rehabilitation to help staff stay at work or return to work after illness 4. Health Assessments for work- to help manage attendance, retirement and related matters 5. Promotion of health and well being using work as a means to improve health and well being and using the workplace to promote health 6. Teaching and training encouraging staff and managers to support staff health and well-being It is essential that Occupational Health Services for healthcare staff meet a minimum specification based on the six core services as listed above and includes the following: All OHS must work towards an accreditation /standards process (Appendix 2) which will include Key Performance Indicators. Service Provision must be clearly defined and include financial reporting Organisations must state clearly the following points, accessibility, equity, independence, inclusiveness, innovation and partnering with communities. Workforce planning must be optimal 2. Occupational health data collection and information sharing in the Irish Health Service The ICT system will be configured in such a way that data management across occupational health services will be managed in a co-ordinated way. Compliance with Occupational Health Service Standards and the integration of Quality Assessment + Improvement will support the above. The following data metrics will apply Activities of the Occupational Health Service The quality of the Occupational Health Service, based on the National Standards /Quality Assessment + Improvement Metrics to monitor Staff Health and Wellbeing e.g. using quantitative data such as sickness absence levels, number of ill health retirements etc. And/or numbers and % responses in the HSE Staff survey e.g. job satisfaction, enjoyment of work, violence at work etc. 23

24 3. Engagement of and with Occupational Health Services in the Irish Health Service Occupational Health Services have taken a transformational leadership approach to engage with all stakeholders to align their services to the delivery of high quality care. Engagement is based within a framework of positive organisational behaviour and includes staff engagement, well being and team engagement. This will be led by the WHWU through implementation of the HSE People Strategy and involvement in Staff Engagement Surveys. See Appendix 8 This will include the collection of metrics as outlined in point 2 Recommendation 2 Future HSE Staff engagement surveys will include more specific metrics to monitor Staff Health and Wellbeing with input from WHWU WHWU s Workforce Planning Methodology to support this Model of Care Context and National Approach Currently a cross- sectoral Steering Group in the Department of Health (2017) is developing a framework for workforce planning for health services in Ireland that will support recruitment and retention of healthcare workers across the health system. The WHWU is continuing to progress workforce planning at an operational and a strategic level using these principles. The workforce planning approach in WHWU for Occupational Health Services in the Irish Health Service involves the following: Main stakeholders are committed to and involved in the planning process with clear lines of responsibility and accountability being defined. Building from a structured information base on current staffing, and relevant activity for departments. Development of an overview analysis to identify need for and scope for change. An agreed unit workforce plan, which will include a cycle of review and update. 24

25 The unit is using a practice development approach; this involves collaboration and engagement, a bottom up and top down approach which is recognised as optimal. This will include the following data collection Measurement and interpretation of demand for Occupational Health Physician Services in the Health Service Assessment and review of organisational characteristics of services care to understand their influence on staffing Examination of the current capacity of the Occupational Health Service to meet service demand Profile the capability of the Occupational Health Physician, Registrars, Registered Nursing Services and Administrative staff for appropriate staffing utilisation. In particular we want to outline the capabilities of physicians who have achieved or are working towards achieving MFOM /LFOM on the specialist register. The development of key performance indicators/key metrics for OHS across the professions and services. (Appendix 3) Measurement of staff engagement levels to enhance positive organisational behaviours 25

26 Supply and Demand Analysis Overview of the Occupational Health Physician Establishment in the Irish Health Service Quantitative data was collected in April 2017 to establish the number of funded Occupational Health Physician posts and contracted sessions for Occupational Health Physicians. Current situation Table 5.Overview of current specialist posts in the Irish Health Service Area Funded Establishment Privately Contracted Permanent Vacancies Specialist Registrars OHP.FTE Sessions (Per month) Sligo General Hospital Temp contract 1 Galway University 1 16 Hospital Limerick University Hospital Cork University Hospital Kilkenny Hospital 1 4 Tullamore Hospital 12 Dr Steeven s Hospital 11 1 Connolly Hospital 1 1 Beaumont hospital.8 1 Tallaght Hospital 1 St James s Hospital 1 1 Mater Misericordiae Hospital St Vincent s University Hospital Children s University Hospital Ou Lady s Hospital for Sick Children.8.5 Our Lady s Hospice 4 North East 1 The National Maternity 8 Hospital The Rotunda Hospital.2 St Michael s Hospital 4 St John s Hospital 4 Limerick 12 Portiuncula Hospital 20 Important notes: One session = 3 hours. 8 All leave- maternity, study leave, sick leave and absences are built in to the existing staffing Establishments 26

27 Current Medical Career Pathways for Occupational Health Physicians Faculty of Occupational Medicine, Royal College of Physicians in Ireland The Faculty of Occupational Medicine in the RCPI is the accredited training body for training in the speciality of occupational medicine and currently has 7 specialist training posts. Specialist Trainees must complete Basic Specialist Training before acceptance on this programme. In addition, the FOM oversees the Licentiate Program and Examination and the Membership Programme of the Faculty of Occupation Medicine (LFOM and the MFOM). Specialist Registrars graduating from the training programme are entitled to Specialist Registration with the Medical Council of Ireland. Those who have acquired the MFOM by alternative means can attain specialist registration via an alternative pathway that is currently poorly defined. This pathway accounts for a small number in the national workforce entering the specialist registrar, less than 3 per year. Current Levels/Grades Currently there are two levels of Physician working in the Occupational Health Physician roles in the services 1. General Physicians who have achieved or who are working towards achieving MFOM (Occupational Health Physicians 2. Physicians on the Specialist Register for Occupational Medicine ( Specialist Occupational Health Physicians) There are various levels of proficiency and capabilities across the grades; as expected in any healthcare setting. A framework for capability and competency development is outlined in appendix 5 Occupational Health Physicians and Irish Health Service Trends At present there are 11.3 FTE Specialist OHP in the Health Services. 25% of OHS in the Irish Health Services are privately contracted. The gender balance at present is 50/50. One third of OHP are working less than full time. Of the existing OHP, 8.3 FTE (75%) are within 10 years of retirement. This is a key finding from a workforce planning perspective in terms of succession planning. 27

28 A recent recruitment campaign in April 2017 attracted a significant expression of interest and competition both in Ireland and internationally. A recent submission to the Department Of Health following an independent review (Hay report) recommended that Specialists in Occupational Health in the HSE be granted Consultant Status and offered equivalent contracts. Specialist Registrar Training Positions. The HSE currently funds seven (7) Specialist Registrar positions in the Faculty of Occupational Medicine in a 4 year programme with 1-2 graduating per year. Unlike other medical specialities, some graduates work in the health services and others are employed in other Irish Public Services e.g. The Civil Service Department of Social Protection Irish Rail Department of Education Dublin Fire Brigade Dublin City Council A number of graduates from the training programme are recruited to the private/independent sector. EWTD compliance is 100%. The gender balance in the Spr is 75:25 in favour of females. The group are culturally diverse. Migration is a not a major factor in comparison to other specialties. 28

29 Alternative Pathway A number of privately contracted Occupational Health Physicians are not specialists but have LFOM qualification work within the Irish Health Service. Approximately two of these doctors are working toward MFOM and specialist registration with the IMC in any three year period. This is an area that has been identified as an area of potential growth as a career pathway as an alternative career. Recommendation 3 The alternative pathway to specialisation should be more clearly defined by the Faculty of Occupational Medicine. WHWU will provide supports to doctors currently working in Occupational Health in the Irish Health Service to progress to specialisation if desired through mentoring, coaching and teaching within existing resources. 29

30 Developing the Workforce Plan for the Heath Service Projected Need for Occupational Health Physicians Currently there are 11 Occupational Health Physicians employed in the Irish Health Service with the clinical equivalent of 6 OHPs contracted privately for Occupational Health Services. (Current provision of contracted services is sessions per month equating to 33 clinical sessions per week. This constitutes a workload for approximately 6 full time OHPs including indirect work and travel time.) It is estimated that taking potential retirements and attrition into consideration the following is the requirement to provide OHP for the next five years (based on date of birth) (Table 2) Table 6 Estimated Projections for Occupational Health Physician Posts for Year Additional OHP Posts Required for the Irish Health Service Posts (unmet demand) Post Posts Posts Posts

31 Recommendation 4 6 OHPs need to be employed immediately to replace private and temporary contracts* In the next 10 years, with normal attrition, the Health Service will need a further 10 OHPs to maintain existing services *A national panel is being formed from an existing campaign and will address this need Current Succession Planning At present there are 7 Specialist Registrars (SpR) in a four year training programme. Two (2) will graduate in June 2017 and one (1) will take Leave of absence. The FOM support flexible working arrangements. 3 new trainees are scheduled to commence the programme in July 2017 The Specialist Registrars are employed in the Health Services and many other public services ( the Police, fire brigade, civil service) on graduation. At any given time 3 Specialist Registrars are working directly in the health service It is important to document that the current number of Specialist Registrars Training Positions will not meet the demand for the profession in the health services alone in the next 5-10 years. 31

32 Table 7. Profile of progression of Current Specialist Registrar Training 2016/ / / / /2021 SpR 1 SpR 2 SpR 3 Yr 1 Yr 2 Yr 3 Yr 4 Graduate July 2021 Yr 1 Yr 2 Yr 3 Yr 4 Graduate July 2021 Yr 1 Yr 2 Yr 3 Yr 4 Graduate July 2021 SpR 4 Yr 1 Yr 2 Yr 3 Yr 4 Graduate July 2021 SpR 5 Yr 1 Yr 2 Yr 3 Yr 4 Graduate July 2020 SpR 6 Yr 2 Yr 2 (LOA) Yr 2 (LOA) Yr 3 Yr 4 Graduate July 2021 Yr 3 Yr 4 Spr 7 Yr 2 Graduate July 2019 Yr 3 Yr 4 Spr 8 Yr 2 Graduate July 2019 Spr 9 Yr 3 Note.5 Yr 4 Note.5 Graduate July 2018 Spr 10 Yr 4 Graduate July Spr 10 Yr 4 Graduate July

33 Proposed Succession Planning The intake of Specialist Registrars needs to be increased significantly. An 8 th position has recently been secured and filled by the WHWU. There is sufficient capacity, and available trainers in existing services to increase this number to 18 for the Irish Health Service alone, given current trends and prediction of 8 retirements in the next ten years. To meet the service demand in the health service, an additional 2 SpRs for the next 4 years is required. Recommendation 5 At a minimum an additional 2 Specialist Registrars be recruited to the training programme year on year for the next five years to bring the total number of training places to 18, by

34 Actions Recommendation 1 and Recommendation 5 A National Workforce Plan for Occupational Health Physicians should be developed in Recommendation 5 At a minimum an additional 2 Specialist Registrars be recruited to the training programme year on year for the next five years to bring the total number of training places to 18, by The Faculty of Occupational Medicine is the Professional Body responsible for the co-ordination of a National Workforce Plan. ACTION: The WHWU will write to the Faculty to recommend this. Recommendation 2 The HSE Staff Engagement surveys in 2018 will include specific metrics to monitor Staff Health and Wellbeing. ACTION: WHWU will engage in the survey design for 2018 Recommendation 3 The alternative pathway to specialisation should be more clearly defined by the Faculty of Occupational Medicine and the WHWU will write to the FOM highlighting this issue. ACTION: WHWU will provide supports to doctors currently working in Occupational Health in the Irish Health Service to progress to specialisation if desired through mentoring, coaching and teaching within existing resources. Recommendation 4 In the next 10 years, with normal attrition, the Health Service will need a further 10 OHPs to maintain existing services ACTION: 6 OHPs are currently being recruited by WHWU and a panel is being formed for temporary vacancies 34

35 References A Report by the All Party Parliamentary Group (2016) Occupational Medical Workforce Crisis. October Government of Ireland ( 2003) Hanly Report of the National Task Force on Medical Staffing. Government of Ireland. Government of Ireland (2016 ) Department of Health, Health in Ireland, Key Trends Future Trends 2016 Government of Ireland. Health Service Executive (2015) Health Service People Strategy , Leaders in People Services. Health Service Executive. Healthy Staff, Better Care for Patients. Realignment of Occupational Health Services to the NHS in England.July NHS Health and Wellbeing Improvement Framework.July employers.org/publications. National Health Service Your Occupational Health Service National Health Service December employers.org/publications. Commissioning Occupational Health Services. December The Boorman Report on the Health and Wellbeing of the NHS Staff: Practical Advice for implementing its recommendations. May

36 Appendices Appendix 1 Framework for Health and Wellbeing Person/Sector Staff Manager Organisation Health System Community Role Personal Responsibility Health checks Prevention Occupational Health Staff engagement WHWU Quality indicators HSE Department of Health Public Health Strategy Government Policy 36

37 Appendix 2. Standards for Occupational Health Services Following an international trend many Occupational Health Services are seeking an accredited service to ensure consistency of services and to provide benchmarking criteria. Currently a set of National Standards for Occupational Health Services are in development with a multidisciplinary consultative group. HIQA Safer Better Care Framework was used as a framework.[ Following consultation with the Health Information and Quality Authority, it was agreed that the service would develop unique standards in line with the Quality Assurance Framework (QAF) Safety and Quality Improvement Directorate. In accordance with the Framework, a Standards Project Group included representatives from Health and Safety, Staff Health and Wellbeing and Occupational Health Services Nationwide. Also an Expert Advisory group was also convened. The draft standards were submitted for broad consultation in April 2017 and the National Standards for Occupational Health Services standards will be launched on May 19 th The aim of these standards is to help drive improvements in the quality and safety of occupational health services in Ireland. Their purpose is to help the public, people who use occupational healthcare and the people who provide them understand what a high quality, safe occupational health service looks like. In particular, the standards will: make sure that service providers are accountable to the public, service users and those who fund them help the people in charge of occupational health services identify what they are doing well, and where they need to improve help make sure that the quality and safety of occupational health services is the same no matter where people live in Ireland or what health service they use no matter where the service is, it should be safe describe what should be in place for day-to-day services to be safe and effective. 37

38 In addition Quality Assurance + Improvement (QA+I) documents were developed to support implementation of the standards. 38

39 Appendix 3. Metrics to Monitor Quality of Occupational Healthcare Metric Note Time from referral to first appointment Time from first appointment to delivery of a report to manager Completeness of Hepatitis B vaccination Prevalence of return to work planning Completeness of referral for long term sickness absence Prevalence of referral of musculoskeletal disorder for treatment Completeness of referral for long term sickness absence 39

40 Appendix 4 Measurement of demand Demand Assessing the volume and profile of health care workers attending OHPs is the first step in identifying basic service demand, to make informed decisions about the OHP workforce. This requires a systematic approach to collection of data. There are a number of potential challenges to measuring demand. These include: inconsistency in the data being collected and reported, capability issues and the resources to collect and interpret the data. However this data is critical to informing and strengthening the understanding of demand for services. Identifying the patterns of presentations to OHPS helps identify potential predictable pressure points in the service and inform changes to produce more effective and efficient staffing deployment. For example the start of an academic year presents an increase in relation to pre employment/clinical placement processes, seasonal workloads associated with flu vaccination clinics. Template for collection of data to measure demand. Total number of presentations to OHD in a one year period How many patients presenting in the same year are assigned to: Assessment and determination of Fitness for work in uncomplicated cases Management referrals seen by OHP Referrals seen by OHN Referrals seen by OHP Health Surveillance work Current Year Previous Year 40

41 Appendix 5 Departmental Structure The impact of the organisational environment is an important feature of workforce planning (Simmons 2011). The physical design of the department has implications for care delivery, that include number of discrete spaces, distances between rooms, treatment bays and diagnostic areas, number of single rooms etc.a first logical step is to consider the current layout/design features of an OHS. This will provide a baseline for current, future and external comparative analysis on an OHP Service. The template below provides a starting point to map current infrastructure and layout from the consideration of a staffing perspective How many reception areas are available? How many clinic rooms are available? What is the seating capacity in the waiting area? How many workstations are available? Are these workstations shared? Are you able to maintain privacy and confidentiality Location and proximity of satellite clinics Is the department located separate from other services? Provide further information What are the design factors that need to be considered? E.g. confidentiality, lighting, signage disability requirements, clinical requirements such as hand wash sinks compliant with hand hygiene stipulations. Is the OHD located near to high use services such as laboratory, pharmacy, storage areas? (Describe the key factors and impact of these locations on how the OHD is staffed) 41

42 Appendix 6 Capability Assessment Capability in the context of workforce planning defines a range of knowledge, skills and experience; either within existing or future workforce. It is essential to ensure that the right person, with the right skills delivers care in the right place. It is designed to increase OHP engagement via targeted development programmes which match current and future service needs. Assessment of OHP capabilities across various grades/roles within the OHS, focusing on academic preparation, mandatory training, OHS specific clinical skills, and composite care competence is key to workforce planning. The Benner Model for competency development from Novice to Expert is used as a reference point. Mandatory Education Profile The facilitation of the Occupational Health Physician to attend mandatory education is critical to both care delivery and the safety of the workforce alike. Facilitation of continuous mandatory education supports the protection of workforce safety along with providing clear objectives to support them to fulfill their role and responsibilities for patient safety (HIQA 2012) for specific elements of care; e.g. data protection / hand hygiene. Assessing this profile element on a regular basis, based on the relevant governing legislation/local policy for training/re-training, facilitates the identification of necessary actions to support compliance. 42

43 Capability Insert the total number (Headcount not WTE) of each OHP grade at the top beside N=. Insert the total number (Headcount) of OHP staff grade with the capability in each section. This will allow you to calculate the overall total and percentage Domain Capability OHP SPR Advanced Beginner Competent Proficient Expert Academic Profile LFOM MFOM Specialist Mandatory Education Profile Minimal Lifting and Handling certified current Fire Training certified current CPR certified current Hand Hygiene Training certified current Specific OHS Skillset Prevention Timely inter Rehab Health assessment Promotion Teach and training Management Referral Vaccinations Leadership Surveillance Complex cases Competent in use of ICT systems Management of client flow Advanced clinical 43